Lantus
Lantus is the brand name for insulin glargine, an insulin analog made by AventisLantus-Insulin Glargine Remedyfind.com. Lantus is a very long-acting insulin (lasting up to 24 hours in humans) that uses pH reactions to form micro-precipitates under the skin, which create a time-release action. Use in Dogs Dogs normally do not fare well with LantusInsulins-North American Veterinary Conference-2005Selecting an Insulin for Treatment of Diabetes Mellitus in Dogs & Cats-Nelson-OSU Endocrinology Symposium 2006-Page 40. Using it for them can mean using the Lantus as a basal insulin with rapid or fast-acting insulins like Humulin R,Novolin R, NovologFDA Novolog New Drug Application--No Faster Action With Insulin Aspart & Dogs or Humalog as bolus insulin, given at mealtimes. This is how insulin-dependent people use it too. Most dogs receive insulin injections twice a day. Using Lantus would possibly double the number of needed daily injections because of the need for the faster-acting insulin at each meal. Dr. Rand participated in a studyof Pharmacodynamics & Pharmacokinetics of Glargine (Lantus), Protamine Zinc (PZI), & Pork Lente Insulin Preparations in Dogs-Fleeman & Rand on the effects of Lantus on dogs. The same 9 healthy dogs were tested with Lantus, beef/pork PZI and porcine (pork) lente insulin. It was concluded that Lantus does not lower blood glucose reliably in dogs; there was no consistent peak time or glucose lowering action, and 2 of the 9 failed to have any significant response at all. PZI was shown to significantly lower bg's with longest duration of action (about 19 hours); pork lente insulin began working faster but had less duration (about 10.5 hours). (A recent studyUsing the Same Syringe for Lantus and Short-Acting Insulin was conducted regarding mixing Lantus and short-acting insulin in the same syringe. The results show that it did not decrease either insulin's effectiveness. There have been more studies like this regarding the combining of Lantus with short-acting insulins. All have been favorable, but the practice has yet to be approved by any regulating body and/or Aventis.) Compare the study regarding mixing Lantus and short-acting insulin in the same syringe for humans and the information from the Lantus US patient information leaflet on the same procedure in dogs: "When Lantus and regular human insulin were mixed immediately before injection in dogs, a delayed onset of action and time to maximum effect for regular human insulin was observedUS-FDA Lantus Patient Information Leaflet-Page 7." The leaflet goes on to say that there was a slight decrease in the bioavailabilityMerck Veterinary Manual-Bioavailability of both insulins--regular human insulin and Lantus--when both were mixed in the same syringe. On the basis of the information above, it would appear that Lantus acts differently in dogs than in humans. Usage and Handling Because of the pH action, Lantus is a bit more sensitive than other insulins -- it needs to have an (acidic) pH of 4 to work, and therefore may not be diluted, mixed with other insulins, or kept overnight in syringes. Lantus and another insulin may be used together in the same patient, but not from the same needle or at the same injection site. Duration/variability People using Lantus who find that it doesn't last long enough to prevent dawn phenomenon sometimes use a small dose of either Lente or NPH in a separate bedtime injection. This seems to work well for themUsing Lantus & Lente/NPH at Bedtime. Some people do not have 24 hours duration from Lantus, having what's called an "afternoon phenomenon", where the Lantus taken at dinner the previous night appears to be waning before their next scheduled injection. This occurs even though they are using rapid-acting analog insulins for bolus meal coverageInsulin Treatment and Type 1 Diabetes Topics--ADA-Diabetes Care-2006. The Lantus prescribing information details a study in humans where it was compared to NPH insulin. The findings were that Lantus has a higher between patient (84%) variability than NPH (78%)Lantus Prescribing Information-US. Same-syringe mixing (A recent studyUsing the Same Syringe for Lantus and Short-Acting Insulin Pages 3 & 4 was conducted regarding mixing Lantus and short-acting insulin in the same syringe. The results show that it did not decrease either insulin's effectiveness. There have been more studies like this regarding the combining of Lantus with short-acting insulins. All have been favorable, but the practice has yet to be approved by any regulating body and/or Aventis.) Compare the study regarding mixing Lantus and short-acting insulin in the same syringe for humans and the information from the Lantus US patient information leaflet on the same procedure in dogs: "When Lantus and regular human insulin were mixed immediately before injection in dogs, a delayed onset of action and time to maximum effect for regular human insulin was observedUS-FDA Lantus Patient Information Leaflet-Page 7." The leaflet goes on to say that there was a slight decrease in the bioavailability of both insulins--regular human insulin and Lantus--when both were mixed in the same syringe. Technical Information The first alteration of human insulin for producing Lantus is found in the A insulin chain at position #21; where normally the amino acid Asparagine is found there, Glycine is substituted. The second modification takes place at the COOH terminus of the B insulin chain, where 2 arginine residues are addedClinchem.org Alterations to Human Insulin Producing Insulins Glargine, Aspart & Lispro. Addition of the 2 arginines at B-#30 and substituting glycine for the normal asparagine at position #21 on the A insulin chain, keeps the insulin in hexamer formEMEA Scientific Discussion-Insulin Glargine-Lantus-Page1. Human insulin unaltered has a natural tendency to remain in hexamer form (self-associate); making these changes to the normal human insulin molecule produces an insulin which tends to remain in hexamer form even longer. Inhibiting the breakdown of the insulin hexamers into dimers and monomers means slower onset, peak and longer duration, as absorption takes longer. Analog Insulins amino acid sequences Analog Insulin pharmacokinetics These are human activity profiles. Studies: Lantus in Dogs *University of Queensland-Pharmacodynamic & Pharmacokinetic Comparison of Glargine (Lantus), Protamine Zinc (PZI), Pork Lente Insulin in Dogs--Fleeman & Rand-2004 Medical and Vet information about Lantus *Medical Info sheet-Sanofi-Aventis *OSU Endocrinology Symposium 2006-Selecting an Insulin for Treatment of Diabetes Mellitus in Dogs & Cats-Nelson-Page 39 References Category:Insulins Category:Analogs Category:long-acting Category:Aventis Category:R-DNA/GE/GM Category:Rx Status Category:Intravenous use NO Category:Meta-cresol Category:Content